Improved Utilization of Serial Testing Without Increased Admissions after Implementation of High-Sensitivity Troponin...

Area of Science:

• Cardiology
• Clinical Chemistry
• Health Services Research

Background:

• Guidelines recommend high-sensitivity cardiac troponin (hs-cTn) for myocardial infarction diagnosis.
• hs-cTn use is increasing, but clinical and operational impacts require further study.
• Previous research on hs-cTn yielded conflicting results due to methodologic limitations.

Purpose of the Study:

• To evaluate the impact of transitioning from conventional cardiac troponin (cTn) to hs-cTn.
• Assessed changes in test utilization, resource use, operational efficiency, and patient safety.
• Examined effects on emergency department (ED) length of stay (LOS) and hospital admission rates.

Main Methods:

• Retrospective cohort study in two New York City hospitals comparing pre- and post-hs-cTn transition periods.
• Included consecutive emergency department (ED) patients with at least one cTn test.
• Utilized a multifaceted hs-cTn intervention bundle including diagnostic algorithms, education, and enhanced electronic medical record and nursing interventions.

Main Results:

• The hs-cTn intervention significantly increased serial cTn testing by 48 percentage points.
• Associated with a modest increase in ED LOS (50 minutes).
• No significant association found with hospital admission probability or 72-hour ED revisit resulting in admission.

Conclusions:

• Implementation of an hs-cTn intervention bundle improved serial cTn testing.
• Observed a neutral effect on hospital admission probability.
• Noted a modest increase in ED length of stay, suggesting a need for workflow optimization.